ORIGINAL ARTICLE

Knowledge, awareness, and practices concerning

breast cancer among Kuwaiti female school teachers

Naif A. Alharbi a, Malik S. Alshammari b, Barjas M. Almutairi a,

Gamal Makboul c,d,*, Medhat K. El-Shazly d,e

a MRCGP, Jahra Polyclinic, Primary Health Care, Ministry of Health, Kuwaitb MRCGP, Saad Al-Abdullah Polyclinic, Primary Health Care, Ministry of Health, Kuwaitc Community Medicine Department, Faculty of Medicine, Alexandria University, Egyptd Department of Health Information and Medical Records, Ministry of Health, Kuwaite Department of Medical Statistics, Medical Research Institute, Alexandria University, Egypt

Received 3 July 2011; accepted 17 October 2011Available online 16 December 2011

KEYWORDS

Female teachers;

Breast cancer;

Knowledge;

Breast self examination

Abstract Background: Breast cancer is by far the most frequent cancer of women. However the

preventive measures for such problem are probably less than expected.

Objectives: The objectives of this study are to assess the breast cancer knowledge and awareness

and factors associated with the practice of breast self examination (BSE) among female teachers.

Methods: This study is a cross-sectional survey of teachers working in schools in Al-Jahra, gover-

norate. A sample of twenty schools was selected randomly by the stratified sampling method from

all schools of the selected governorate that included primary, intermediate and secondary schools.

All ever married Kuwaiti female teachers working in the selected schools were asked to fill a self-

administered questionnaire to investigate their knowledge about the risk factors of breast cancer,

their awareness and screening behaviors. Data were collected from 421 female teachers with

87.5% response rate.

* Corresponding author at: Community Medicine Department,

Faculty of Medicine, Alexandria University, Egypt. Tel.: +965

97167528.

E-mail address: gamalmakboul@hotmail.com (G. Makboul).

2090-5068 ª 2011 Alexandria University Faculty of Medicine.

Production and hosting by Elsevier B.V. All rights reserved.

Peer review under responsibility of Alexandria University Faculty of

Medicine.

doi:10.1016/j.ajme.2011.10.003

Production and hosting by Elsevier

Alexandria Journal of Medicine (2012) 48, 75–82

Alexandria University Faculty of Medicine

Alexandria Journal of Medicine

www.sciencedirect.com

Results: The results of the study showed that 67.5% of the participants declared that they had

information about breast cancer and their sources of information were mainly health profession-

als/workers (98.2%), friends/neighbors (83.5%), TV/Radio (76.0%) and printed materials

(60.2%). Of the participants, 18.5% reported positive family history of breast cancer, 49.9% did

not know how to practice BSE, 29.0% knew the procedure but never applied it. Moreover,

81.9% has no breast examination by health professionals and 85.7% did not know what the mam-

mography is. The factors that may have an impact on acquiring satisfactory level of knowledge

were, women older than 40 years, married, user of contraceptive pills, with a history of child death.

Conclusions: The study points to the insufficient knowledge of female teachers about breast cancer

and identified the negative influence of low knowledge on the practice of BSE.

ª 2011 Alexandria University Faculty of Medicine. Production and hosting by Elsevier B.V. All rights

reserved.

1. Introduction

Breast cancer is by far the most frequent cancer of women

(23% of all cancers), ranking second overall when both sexesare considered together. It is the leading cause of cancer mor-tality in women and constitutes 14% of female cancer deaths.1

Incidence rates are increasing in most countries, and thechanges are usually greatest where rates were previouslylow.2 In Saudi Arabia, while it had once been presumed that

the incidence of breast cancer was low; more recent data haveindicated that it is a significant disease in this community, aselsewhere in the world.3,4.

The pattern of breast cancer in Arab countries is very dis-turbing.3,5,6 For Kuwaiti females breast cancer had the highestincidence among Kuwaiti population (15 cases/100,000 popu-lations), it increased by 3 folds (50 cases/100,000 populations)

over the last 33 years.7 The impression among Arab physiciansdealing with breast cancer is that it presents at an earlier ageand at a more advanced stage as compared to western coun-

tries. However, the statistical data to support this impressionare remarkably scarce.8

The risk of breast cancer increases with age. The primary

factors that increase the risk of breast cancer in women includecertain inherited genetic mutations, a personal or family his-tory of breast cancer, and biopsy-confirmed hyperplasia.9

Since breast cancer is a progressive disease, small tumors are

more likely to be at an early stage and their early detectionis more likely to have more successful treatment and a betterprognosis.10 The three screening tests usually considered for

early detection are clinical breast examination (CBE), X-raymammography, and breast self examination (BSE).11,12 Inindustrial countries breast cancer mortality is declining where

screening mammography is the standard for care.13 BSE isappealing as a patient-centered, non-invasive screening proce-dure that allows women to become comfortable with their own

bodies.14

Regular performance of BSE does not mean that the breastcancer is necessarily self detected. BSE increases body aware-ness, so that there is heightened awareness of changes that

may be detected during BSE or at some other time.1 Although,the American Cancer Society recommended in 2003 that wo-men beginning in their 20s should be told about the benefits

and limitations of BSE, this procedure is not considered thebest method for early detection but the best option for intervalscreening among women of all ages.15

The importance of knowledge of these risk factors and theneed for every woman to be aware of the need for surveillance

on her breasts and the various ways to do this cannot be overemphasized. The poor knowledge and wrong beliefs about can-cer breast prevention among women are responsible for a neg-

ative perception of the curability of a cancer detected early andof the efficacy of the screening tests.16 Studies that detect theawareness of breast cancer and the practice of BSE among

Arab women were few and pointed to a lack in breast cancerknowledge of females.17–20

Since teachers play an effective role in communication andmotivation of young students, assessment of their knowledge,

attitudes and behaviors is essential to reduce the risk of breastcancer among future young generations. However, the practiceof any of these screening methods is dependent on the aware-

ness about breast cancer. If this knowledge is poor amongthose who should teach others, there will be difficulty in pro-moting these life saving methods. Therefore, this study was de-

signed to evaluate the knowledge, attitude and practice ofbreast cancer screening among female teachers. This studyaimed to determine breast cancer related knowledge, aware-

ness, risk factors and screening behaviors among Kuwaiti fe-male teachers in order to introduce the best intervention plans.

2. Methodology

2.1. Setting

The studied population consisted of the ever married Kuwaitifemale teachers working in the females’ primary, intermediate

and secondary schools in Al-Jahra governotate, Kuwait. Thisstudy is a cross-sectional survey that was conducted fromOctober 2009 to May 2010. Assuming that about 50% of

women lack knowledge about breast cancer risk factors andscreening methods with absolute precision of 5%, the requiredsample size was estimated to be 481 women (considering the

confidence limits to be 95%). After adding 10% for non-re-sponse, it turned out to be 530. The number of teachers ex-pected to be studied in each school was estimated to beabout 25. Data were collected from 421 female teachers with

87.5% response rate. In Each selected school, all ever marriedfemale teachers were invited to participate in the study.

2.2. Data collection

A predesigned self-administered questionnaire was used to col-

lect the information from the teachers. The questionnaire wasderived from other published studies dealing with the same to-pic as well as from our own experience.21–25 It included ques-

76 N.A. Alharbi et al.

tions related to personal data and history of related health

events. It also investigated the knowledge and awareness ofteachers regarding breast cancer and their practice of screeningprocedures. The data collection process was made by the inves-tigators themselves. An Arabic version of the data collection

form was used. The structured English form was first trans-lated into Arabic by an author. This version was revised andtranslated back to English by another author and compared

with the original form to ascertain the precision of translation.Knowledge about the risk of breast cancer was assessed by

questionnaire items. These items included having had breast

cancer once before, late age at first pregnancy, early onset ofmenstruation, having had a breast biopsy, having a family his-tory of breast cancer, advanced age and late onset of meno-

pause in addition to five items recently identified, namelybreast feeding, exposure to radiation, hormonal treatment,high fat diet and obesity.

The knowledge of women about the common screening

methods (mammography, clinical breast examination andbreast self examination) was assessed by asking three ques-tions. The source of knowledge was detected by asking the par-

ticipant to define a source of her knowledge about breastcancer; it was permissible to give more than one source.

A pilot study was carried out on 30 female teachers (not in-

cluded in the final study). This study was formulated with thefollowing objectives: test the clarity of the questions, test thevalidity and applicability of the study tools, accommodatethe aim of the work to actual feasibility, identify the difficulties

that may be faced during the application, as well as study allthe procedures and activities of the administrative aspects.Also, the time of completing the questionnaire was estimated

during this pilot study to be 10 min. The necessary modifica-tions according to the results obtained were done, so somestatements were reworded. Also, the structure of the question-

naire sheet was reformatted to facilitate data collection.A positive answer was assigned one point, whereas a nega-

tive answer was given zero. Percent score was calculated for

the total knowledge score as ‘‘sum of score multiplied by100/number of answered questions’’. The median value ofthe percentage score of all the participants was 63.6%. Usingthis median value as a cut off point, participants were classified

into groups: low level group (with scores less than the median)and satisfactory level group (with scores equal or higher thanthe median).

All the necessary approvals for carrying out the researchwere obtained. The Ethical Committee of the Kuwaiti Ministryof Health approved the research. A written format explaining

the purpose of the research was prepared to be signed by theteachers. In order to maintain confidentiality, questionnaireswere made anonymous.

2.3. Data analysis

The Statistical Package for Social Sciences (SPSS-17) was used

for data processing. Simple descriptive statistics were used(mean ± standard deviation for quantitative variables, andfrequency with percentage distribution for categorized vari-

ables). To find out the most important factors considered aspredictors of having satisfactory knowledge, a logistic regres-sion analysis was used. A model was developed using all fac-

tors suspected to be associated with satisfactory knowledgelevel.

The association between the studied variables and level of

outcome of interest were expressed in terms of odds ratios(OR) together with 95% confidence intervals (95% CIs). Allthe explanatory variables included in the logistic model werecategorized into two or more levels (R = reference category):

Age groups:<30R, 30–39, P40; Marital status: divorced orwidowR, married; Duration of marriage: 1–5R, 6–10, 11–15,16–20 P 20; Husband education: less than secondaryR, sec-

ondary, university; Husband work: noneR, governmental, pri-vate, student; Number of children: 0R, 1–2, 3–4, P5;Regularity of menstruation: noR, yes; Stop of menstruation:

noR, yes; History of abortion: noR, yes; History of child death:noR, yes; Methods of contraceptives: noneR, pills, others;Family/friend history of breast cancer: noR, yes. A 5% level

is chosen as a level of significant in all statistical significancetests.

3. Results

Four hundred twenty-eight female teachers agreed to partici-pate in the study and returned back the filled questionnaires.

Of them, only seven cases were never married, who were ex-cluded from the analysis. Table 1 shows general characteristicsof study population. Participants in this study were 421 ever

married Kuwaiti female teachers working in primary, interme-diate and secondary schools in Jahra governorate in Kuwait.Their mean age was 33.4 ± 5.3 years (ranged between 21 and

58 years). Most participants (85.7%) were aged less than40 years and were married (95.2%) or ever married (4.8). Morethan two-thirds of the participants were married for more than5 years (71.7%). Most of husbands had secondary or univer-

sity education (79.3%) and had governmental work (82.9%).Two-thirds (64.8%) of the participants have three children ormore, and only 7.8% have no children. The majority

(81.7%) has regular menstruation, 2.9% mentioned that theirmenstruation stopped, 40.9% had history of abortion, 8.8%had history of child death, and 47.3% were using pills as con-

traceptive method. About two-thirds (67.5%) of the partici-pants had information about breast cancer. The source ofinformation for those was mainly from health professionals/

workers (98.2%), friends/neighborhood constituted 83.5%,TV/Radio 76.0% and 60.2% from printed media (books/bro-chures/magazines). The same table revealed that 18.5% re-ported positive family history of breast cancer with different

proportion among the family members and friends.Participants’ knowledge regarding the symptoms and signs

of breast cancer were inquired about. The percentages of those

who answered correctly for each items were presented in Table2. The percentages were 88.8% for the presence of breast mass,83.6% for enlargement of neighboring lymph nodes, 73.9% for

abnormal enlargement of breast, 68.9% for bloody dischargefrom nipple, 66.3% for breast pain, 64.6% asymmetric saggingin breast. Only 47.0% answered correctly the questions about

nipple retraction, and 42.8% about breast skin retraction. Ta-ble 2 also revealed that, when asked about variables that mayaffect the probability of breast cancer, more than three quar-ters of teachers (78.6%) answered correctly about the effect

of breast feeding, 63.7% about the effect of smoking, 54.2%about family history of breast cancer, 51.1% about the effectof hormone replacement therapy, 50.1% about the effect of

using alcohol. However, only 35.4% answered correctly about

Awareness of breast self examination 77

the effect of aging. Other risk factors were recognized by less

than one quarter of participants. Least recognized risk factorswere menarche age and having benign breast disease.

Table 3 illustrated participants’ knowledge and the fre-

quency of application of breast examination. About one half

(49.9%) of the teachers declared that they do not know how

to practice BSE, 29.0% of them knew the procedure but neverapplied it, 14.0% applied it when they remembered, theremaining 7.1% of the participants applied the techniqueeither on weekly, monthly or yearly basis. Moreover, 81.9%

had no breast examination by health professionals and85.7% did not know what is mammography.

Table 4 revealed participants’ opinions about reasons of

starting to perform BSE monthly. About two thirds (61.3%)of women reported that they can started if they became fearof breast cancer, 29.2% if there is a pain and 24% if they felt

a mass, nearly equal proportions reported that they can startedif they heard from the media or according to doctor’s advice,(17.6% and 17.3% respectively). When asked about reasons

for non practicing BSE monthly, participants’ answers in-cluded lack of knowledge about BSE and its value (43.5%),absence of breast complaints (33.0%), forgetfulness (26.1%),fear of finding a lump (20.9%) and dislike to touch breasts

(13.3%).Table 5 presents factors that may have an impact on acquir-

ing satisfactory knowledge about breast cancer. Among these

variables, older age (40 years and over) was significantly re-lated to higher knowledge level (OR = 1.5 & 95% CI: 1.2–3.9). Married women showed significant better knowledge level

than Divorced or widow (OR = 3.3 & 95% CI: 1.1–9.7).Teachers with history of contraceptive pills were at higherknowledge score than non-users (OR = 1.3 & 95% CI: 1.1–2.4). Similarly, women with history of child death showed sig-

nificant better knowledge level than others (OR = 1.9 & 95%CI: 1.3–3.9). Other variables; showed no significant associationwith knowledge level.

4. Discussion

The average age at the presentation of breast cancer in Arabcountries appears to be a decade earlier than in Western coun-tries. If this is true, this has important implications for screen-

ing and cancer management strategies in these countries,including the ideal age at which to begin screening. Adoptionof Western guidelines ‘‘without critical amendment’’ in plan-

ning breast cancer programs will waste the resources withoutachieving desired outcomes. Determination of the true fre-quency and age of onset of breast cancer in Arab womenshould be an important research priority.8

In the present study, respondents answered correctly thatthe commonest symptom of breast cancer is a breast mass.Even though, 17.7% of respondents believed that the mass ex-

pected to be malignant when it is usually of large size and oftentime visible. In a similar study carried out among femaleschool teachers in Lagos, only 53.3% knew correctly that a

mass was the commonest recognized symptom of breast can-cer.26 In another study among a Nigerian population, only33% of the population studied knew that a breast lump could

be a warning sign of breast cancer.27

In the present study, 68.9% of the participants answeredcorrectly when they asked about bloody discharge from nipple,83.6% about enlargement of neighboring lymph nodes 73.9%

abnormal enlargement of breast, 66.3% about breast pain,64.6% about asymmetric sagging in breast, only 47.0% an-swered correctly the questions about nipple retraction, and

42.8% about breast skin retraction. Similarly, in the study

Table 1 General characteristics of participants.

Variables No %

Age groups

<30 120 28.5

30–39 241 57.2

P40 60 14.3

Marital status

Divorced or widowed 20 4.8

Married 401 95.2

Duration of marriage

1–5 119 28.3

6–10 125 29.7

11–15 107 25.4

16–20 45 10.7

P20 25 5.9

Husband education

Less than secondary 87 20.7

Secondary 141 33.5

University 193 45.8

Husband work

None 17 4.0

Governmental 349 82.9

Private 52 12.4

Student 3 0.7

Number of children

0 33 7.8

1–2 111 26.4

3–4 150 37.0

P5 117 27.8

Regularity of menstruation

No 77 18.3

Yes 344 81.7

Stop of menstruation

No 409 97.1

Yes 12 2.9

History of abortion

No 249 59.1

Yes 172 40.9

History of child death

No 384 91.2

Yes 37 8.8

Methods of contraceptive use

None 138 32.8

Pills 199 47.3

Others 84 20.0

Information about breast cancer

No 137 32.5

Yes 284 67.5

Family/friends history of breast cancer

No 343 81.5

Yes 78 18.5

Total 421 100.0

78 N.A. Alharbi et al.

carried out by Haji-Mahmoodi et al.,28 only 27% knew that

pain is not a cardinal feature of breast cancer. Other studieshave also reported similar findings.29,30 These wrong informa-tions or assumptions about breast lumps may account for

some of the reasons why some of our patients present late tohospital.29–32 In the study on why patients with breast cancerpresent late for management, several studies found that major-ity of the patients has a wrong perception of malignant dis-

eases of the breast, particularly the early symptoms of breastcancer.33–37

In terms of associated risk factors for breast cancer, only

36.3% of the respondents knew that breast cancer affectingone breast is a risk factor for developing breast cancer of theother breast. About one half (54.2%) respondents knew that

a positive family history of breast cancer is a risk factor, whileonly 32.8% knew that obesity is also an implicated risk factor.Most of the respondents interviewed in this study did not

know the association between breast cancer and early menar-che (3.8%), late menopause (20.9%), use of oral contraceptives(38.2%), increasing age of patient, women that do not breast-feed (78.6%) and age at first child birth (19.0%). However,

some studies have shown that the incidence of breast cancer

is said to be slightly higher in persons that have first degree rel-atives with a history of breast cancer, persons that have earlymenarche and late menopause and those that use oral contra-ceptives, persons do not breast feed and those women having

their first birth after age 35 or nulliparous women. The inci-dence is also increased with increasing age of the patient,smoking, obesity, physical inactivity, radiation exposure, in-

take of alcohol and high fat diet.26,29,36 Thus further healtheducation on associated risk factors and protective factors isdesirable. This may influence the attitudes, practices and life-

style of our patient positively. In a study done by Adebamowoet al.,36 it was observed that patients with positive family his-tory tend to present early for management. In the present

study, 36.3% of the respondents knew that breast cancer couldspread to the contralateral breast. In addition, 35.7% of therespondents believes that breast cancer is usually limited tothe breasts, and that it does not spread to other parts of the

body, while 59.7% knew correctly that breast cancer canspread to other parts of the body. Other studies on the knowl-edge about breast cancer have reported similar findings.38,39

Another major factor why we experience late presentationof breast cancer is that most women do not carry out breastself examination and they do not also take advantage of the

screening role of mammography. It is either that they havenever heard of breast self examination or they do not knowhow to carry it out.38–40 It is also possible that they can carryout BSE, but the motivation to carry it out is absent. In the

present study, 49.9% of the respondents have never heardabout BSE, while 29.0% of them knew the procedure but neverapplied it, but only 14.0% applied it when they remembered,

the remaining 7.1% of the participants applied the techniqueeither in weekly, monthly or yearly basis. Several studies onBSE have reported similar findings.40–44 This may be as a re-

sult of poor health education in our society. In a study doneamong secondary school teachers, only about 25% had ade-quate knowledge of breast self examination.42 The implication

therefore is that 75% of such a group of teachers cannot im-pact on their students the importance of BSE. Freemanet al.45 also emphasized the need for adolescents to be properlytaught the routine of BSE as this will greatly influence their

practice as they grow older. A related study showed that somenurses do not appreciate the importance of BSE and the needfor CBE.42 The implication of all of these is that there is the

need for proper orientation about breast cancer among thevarious caregivers which in turn is expected to boost the levelof awareness in the society.

The knowledge of the use of mammography as a screeningtool for early detection of breast cancer was found to be pooramong our respondents. Only 14.3% of the respondents have

heard about screening mammography. A similar finding wasreported by Okobia et al.46 Health education about the bene-fits of mammography screening should be encouraged.

Women’s limited knowledge about breast cancer has been

identified elsewhere in developed and under developingcountries.40,47,48

Participants showed poor understanding of major breast

cancer risk factors. The most identified risk factors were nonbreast feeding and hormonal treatment, which might reflectthe religious culture that encourages, breast feeding and natu-

ral methods of birth control. Several misconceptions concern-ing women opinions about the reasons of starting and barriers

Table 2 Percentage of participants having correct knowledge

about items related to signs, symptoms and risk factors of

breast cancer.

Items No %

Symptoms and signs of breast cancer

Bloody discharge from nipple 290 68.9

Asymmetric sagging in breast 272 64.6

Breast mass 374 88.8

Breast pain 279 66.3

Enlargement of neighboring lymph nodes 352 83.6

Breast skin retraction 180 42.8

Abnormal arm swelling 188 44.7

Nipple retraction 198 47.0

Discoloration of breast 259 61.5

Abnormal enlargement of breast 311 73.9

Ovarian pain 259 61.5

Factors affecting the probability of breast cancer

Aging 149 35.4

Nulliparity 108 25.7

Age of first delivery above 30 80 19.0

Pregnancy at early age 84 20.0

Menopause age above 50 88 20.9

Age of menarche under 11 16 3.8

Counter-lateral cancer formation in breast cancer patients 153 36.3

Family history of cancer 228 54.2

Obesity 138 32.8

Oral contraceptives 161 38.2

Breast feeding 331 78.6

Alcohol drink 211 50.1

Smoking 268 63.7

Radiation exposure 188 44.7

Having benign breast disease 35 8.3

Hormone replacement therapy 215 51.1

Sunlight exposure 184 43.7

Consumption of fatty foods 157 37.3

Consumption of spicy foods 121 28.7

Personal hygiene 108 25.7

Total 421 100.0

Awareness of breast self examination 79

for practicing BSE monthly have been mentioned in this studyas fear of breast cancer, lack of knowledge about BSE and itsvalue, no breast complaints, forgetfulness. This is consistent

with beliefs of women in other societies with different culturessuch as the Philippines, Korea and Australia.49,50

Among the predictors of satisfactory knowledge level in this

study, older age, marriage, history of child death, and use ofcontraceptive pills were the strongest significant variable. Asso-ciation of breast cancer knowledge with these variables has

been identified in other studies. Data from the National Amer-ican Survey on cancer risk revealed poor knowledge among thepoorest and least educated women.48 Similar findings were re-ported among Hispanic women.51 Many factors were signifi-

cantly responsible for a better knowledge level. Participantsaged 40 years and over showed the best level of knowledge.However, many studies pointed to the negative association of

knowledge scores with age.52–54 The age of participants in thisstudy is considered fairly young (33.4 ± 5.3 years) which coin-cides with the literature. This variation could be attributed to

the health education activities of local organizations that weredirected to school teachers as well as female organizations.55

5. Conclusions

The study points to the insufficient knowledge of female teach-

ers about breast cancer and identified the negative influence oflow knowledge on the practice of BSE. Accordingly, relevanteducational programs, based on a national base, to improvethe knowledge level of women regarding breast cancer are

needed. There is very urgent need for regular update coursesfor health workers concerning breast cancer education includ-ing screening methods.

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Table 3 Knowledge and frequency of breast examination

among the Participants.

Method of examination No %

Frequency of practicing BSE

I do not know how 210 49.9

Yes I know, but never applied 122 29.0

Yes I apply whenever it comes my mind 59 14.0

Yes I apply once a week 4 1.0

Yes I apply once a month 8 1.9

Yes I apply every 2–4 month 4 1.0

Yes I apply every 5–6 month 8 1.9

Yes I apply every 7–11 month 1 0.2

Yes I apply once a year 4 1.0

Other 1 0.2

Breast examination by health professionals

No 345 81.9

Yes as I had a breast problem 47 11.2

Yes yearly 12 2.9

Others 17 4.0

Mammography

I have no knowledge 361 85.7

I have knowledge but never did 38 9.0

Yes yearly 8 1.9

Yes/2 years 6 1.4

Others 8 1.9

Total 421 100.0

Table 4 Participant’ opinions about reasons of starting and

barriers for practicing breast self-examination monthly.

Participants’ opinion No %

Reasons of starting to perform breast self-examination monthly

Fear of breast cancer 258 61.3

Media 74 17.6

Doctor’s advice 73 17.3

Breast pain 123 29.2

Advice of a health worker 21 5.0

Nipple discharge 48 11.4

The feeling of a mass 101 24.0

Breast cancer in the family 57 13.5

Encouraged by a friend 40 9.5

Others 13 3.1

Barriers for practicing breast self-examination monthly

Lack of knowledge (about BSE and its value) 183 43.5

Dislike to touch breasts 56 13.3

Fear/worry to find a lump 88 20.9

No time for BSE 52 12.4

Forgetfulness 110 26.1

No breast complaints 139 33.0

Culture and health beliefs 13 3.1

Unavailability of specialized centers 47 11.2

Absence of lump during previous examination 30 7.1

Under estimate the problem of breast cancer 48 11.4

Others 9 2.1

Total 421 100.0

Table 5 Factors affecting level of knowledge among partic-

ipants, results of multiple logistic regression analysis.

Variables OR 95% CI

Age groups

<30R 1.0 –

30–39 1.0 0.5–1.8

P40 1.5 1.2–3.9

Marital status

Divorced or widowR 1 –

Married 3.3 1.1–9.7

History of child death

NoR 1 –

Yes 1.9 1.3–3.9

Methods of contraceptives

NoneR 1.0 –

Pills 1.3 1.1–2.4

Others 1.6 0.8–3.0

R = Reference category. OR = Odds ratio. CI = Confidence

intervals.

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husband education, husband work, number of children, regularity

of menstruation, stop of menstruation, history of abortion, history

of child death, methods of contraceptives, family history of cancer.

80 N.A. Alharbi et al.

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